France, the world’s most depressed nation?

France was proclaimed “world champion of misery” by its own press this week after a report published in the US rated the French as most likely to suffer from clinical depression. The statistics are there, but is the reality?

A World Health Organisation (WHO) report published in the US last week signalled French people as the most likely to suffer from a “major depressive episode” in their lifetimes, provoking sensational headlines among the more neurotically-inclined members of the Gallic press.

The study, which was conducted by researchers from the State University of New York at Stony Brookas part of the WHO's World Mental Health Survey Initiative, was published on July 26 by esteemed American journal BMC Medicine. Some 90,000 people were probed on their mental health histories in 18 low- and high-income countries. It has been touted as the first international survey of its kind.

The results are impressive – while participants from low-income countries appeared less likely to suffer from depression at some point in their life, those from high-income nations seemed far more likely to suffer. France topped the list by one percentage point.

The deafening conclusion – “France, a depressed nation” or “Depression: France tops world ranking,” soon hit the headlines. The notion is not entirely novel to the French, who learned in 2008 that they consume more anti-depressants than any other country.

Prevalence of major depressive episodes in participating countries:

• France: 21%

• USA: 19.2%

• Brazil: 18.4%

• Netherlands: 17.9%

• New Zealand: 17.8%

• Ukraine: 14.6%

• Belgium: 14.1%

• Colombia: 13.3%

• Lebanon: 10.9%

• Spain: 10.6%

• Israel: 10.2%

• Italy: 9.9%

• Germany: 9.9%

• South Africa: 9.8%

• India: 9%

• Mexico: 8%

• Japan: 6.6%

• China: 6.5%

This new evidence served as further fuel to the pessimists, who eagerly offered up an array of fantastic explanations for the nation’s unparalleled tristesse. An article on health forum Psychiatrie.fr blamed, among other things: financial woes, the government’s raising of the retirement age, too much Prozac, and finally, that notorious “French tradition” -- post-holiday January blues.

Online comments went ever further, suggesting that French people are too intellectual for their own good, that they are born cynical, or even that they don’t take enough recreational drugs to get them through the day. According to one seemingly well-travelled commentator, Londoners and Quebecois steer clear of doom and gloom with a constant supply of cocaine and amphetamines.

Depressed or obsessed?

“We cannot conclude from this study that the French are more depressed than people from any other country,” says mental health researcher, Xavier Briffault, of France’s national research institute, CNRS. “The results of research like this are incredibly sensitive to the methods used to obtain them.”

Briffault, who worked on a 2008 study into the methodology of mental health research, argues that asking the same question of someone in France, and then India, for example, will not provoke the same response. “In developed countries people are very accustomed to hearing and talking openly about depression,” he explained in an interview with FRANCE 24. “In low-income countries that is not the case.” The translation and cultural adaptation of questions so that they can be understood across the board in many countries, Briffault says, is near impossible.

And while the WHO study included a lengthy screening programme and face-to-face interviews, it was up to those selected to decide whether they would take part or not. The average response rate was 71.7%, but in France it reached just 45.9%, making the French sample unrepresentative in terms of size.

Briffault also dismissed France’s high level of anti-depressant consumption as proof of the extent of the problem. “High consumption doesn’t indicate depression levels,” he said. “It indicates doctors’ willingness to prescribe the drugs.”

On the forums however, they’ve made their minds up for themselves. France is depressed and everybody should know why. “It’s obvious,” one commentator insists. “We spend too much time reading surveys.”